Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 01077302A | IN |
N | 207RC0000X | Internist - Cardiovascular Disease | MC-0231 | ID |
N | 207RC0000X | Internist - Cardiovascular Disease | MD00047746 | WA |
N | 207RC0000X | Internist - Cardiovascular Disease | MD186722 | OR |
N | 207RI0011X | Interventional Cardiology | MC-0231 | ID |
N | 207RI0011X | Interventional Cardiology | MD00047746 | WA |
Y | 207RI0011X | Interventional Cardiology | MED-PHYS-LIC-45806 | MT |
NPI | 1083654313 |
---|---|
Provider Name | Ellen H Chen |
First Address | Renton, WA 98058-2028 |
Second Address | Coos Bay, OR 97420-2198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 24/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000001041073 | ANTHEM PROVIDER NUMBER (01) | IN |
0248026 | L&I (01) | WA |
1015CH | REGENCE (01) | WA |
201379160 | (05) | IN |
815500172 | (02) | IN |
8478695 | (05) | WA |
8951017 | CRIME VICTIMS (01) | WA |